title: Effects of respiratory and non-respiratory factors on disability among older adults with airway obstruction: the Cardiovascular Health Study.
abstract: BACKGROUND
  High rates of disability associated with chronic airway obstruction may be caused by impaired pulmonary function, pulmonary symptoms, other chronic diseases, or systemic inflammation.
  
  
  METHODS
  We analyzed data from the Cardiovascular Health Study, a longitudinal cohort of 5888 older adults. Categories of lung function (normal; restricted; borderline, mild-moderate, and severe obstruction) were delineated by baseline spirometry (without bronchodilator). Disability-free years were calculated as total years alive and without self-report of difficulty performing &γτ;1 Instrumental Activities of Daily Living over 6 years of follow-up. Using linear regression, we compared disability-free years by lung disease category, adjusting for demographic factors, body mass index, smoking, cognition, and other chronic co-morbidities. Among participants with airflow obstruction, we examined the association of respiratory factors (FEV1 and dyspnea) and non-respiratory factors (ischemic heart disease, congestive heart failure, diabetes, muscle weakness, osteoporosis, depression and cognitive impairment) on disability-free years.
  
  
  RESULTS
  The average disability free years were 4.0 out of a possible 6 years. Severe obstruction was associated with 1 fewer disability-free year compared to normal spirometry in the adjusted model. For the 1,048 participants with airway obstruction, both respiratory factors (FEV1 and dyspnea) and non-respiratory factors (heart disease, coronary artery disease, diabetes, depression, osteoporosis, cognitive function, and weakness) were associated with decreased disability-free years.
  
  
  CONCLUSIONS
  Severe obstruction is associated with greater disability compared to patients with normal spirometery. Both respiratory and non-respiratory factors contribute to disability in older adults with abnormal spirometry.
authors.affiliation: 1Health Services Research and Development, Department of Veterans Affairs, Seattle, WA, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Locke
authors.forename: Stephen
authors.initials: S
authors.lastname: Thielke
authors.forename: Paula
authors.initials: P
authors.lastname: Diehr
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Wilsdon
authors.forename: R Graham
authors.initials: RG
authors.lastname: Barr
authors.forename: Nadia
authors.initials: N
authors.lastname: Hansel
authors.forename: Vishesh K
authors.initials: VK
authors.lastname: Kapur
authors.forename: Jerry
authors.initials: J
authors.lastname: Krishnan
authors.forename: Paul
authors.initials: P
authors.lastname: Enright
authors.forename: Susan R
authors.initials: SR
authors.lastname: Heckbert
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kronmal
authors.forename: Vincent S
authors.initials: VS
authors.lastname: Fan
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D003072:Cognition Disorders / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D018450:Disease Progression; D004417:Dyspnea / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D018908:Muscle Weakness / Q000453:epidemiology; D017202:Myocardial Ischemia / Q000453:epidemiology; D010024:Osteoporosis / Q000453:epidemiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000503:physiopathology*; D012720:Severity of Illness Index; D013147:Spirometry